As dietitians, we’re all familiar with the eight major allergens and how to identify them on a food label. As a school dietitian that deals with student allergies daily, I thought I had a leg up—it’s my responsibility to keep students safe, and I’ve taken comprehensive trainings, scoured the internet for all the articles, and attended numerous conferences.
So, when my infant niece was diagnosed with food allergies, her parents turned to me for guidance. She’s allergic to tree nuts, sesame, and nonbaked eggs. The first two I was sure about—but nonbaked eggs? I’d always learned that you couldn’t “cook out” an allergen, so I was baffled. Could this just be an egg intolerance that her allergist was labeling as an allergy? Would she be unnecessarily avoiding eggs for her entire life because her doctor had incorrectly diagnosed her?
The answer is no. Although food allergies often are treated with strict avoidance, according to the nonprofit organization Food Allergy & Anaphylaxis Connection Team (FAACT), as many as 70% to 80% of people with egg allergy safely can consume baked eggs, such as the eggs you’d find in a cake or other baked goods.
Egg Allergy Overview
As one of the eight major allergens, egg is required to be listed by common name on all food labels in the United States.
There are several potentially allergenic proteins in egg, most of which are in the egg white. The three most allergenic proteins are ovalbumin, ovomucoid, and ovotransferrin. Although egg yolk is less likely to cause an allergic reaction, it isn’t recommended for egg-allergic people to consume because it’s difficult to separate the white and yolk sufficiently enough to be safe.
In general, most kids outgrow egg allergy—as many as 66% of children with egg allergy can tolerate eggs by age 5. Children with multiple food allergies or with high egg-specific immunoglobulin E (IgE) levels are less likely to outgrow their egg allergy.
Egg allergy is unique in that—contrary to common belief—it can sometimes be cooked out. While the ovomucoid and ovotransferrin proteins are heat stable, ovalbumin isn’t. With extensive heating, the ovalbumin protein breaks down, which changes its structure and makes it unable to bind IgE. Because of this break down, people who are allergic to the ovalbumin protein in eggs often safely can tolerate eggs that have been baked.
What Qualifies as a Baked Egg?
To break down the ovalbumin protein, baked eggs should be cooked at a minimum of 350° F for at least 30 minutes; recipes shouldn’t contain more than two eggs per batch to limit the quantity of egg consumed. It’s recommended that individual portions of a recipe be made, rather than a large batch (eg, cupcakes instead of a cake), to ensure the middle is completely cooked through. People should avoid sauces, dressings, custards, and other recipes in which the egg is raw or isn’t extensively cooked, as they’re unsafe to consume.
Packaged products can present a challenge because, although a label is required to list egg, it doesn’t indicate exactly how the egg was cooked or how the product was prepared. In these cases, FAACT recommends only trialing products that list egg as the third ingredient or lower.
Milk Is Following in Egg’s Footsteps
FAACT also reports that about 75% of people allergic to milk protein safely can consume a small quantity of milk that has been extensively heated. However, research into this phenomenon appears to be ongoing, and currently there are no widely accepted recommendations for introducing baked milk into a milk-allergic person’s diet. However, some allergists have started giving specific recommendations to individual patients for introduction of baked milk.
What Can RDs Do?
In a school setting, it may be challenging for staff to determine which (if any) eggs an egg-allergic student can eat. School dietitians and foodservice staff should work with parents and the student’s doctor to determine the appropriateness of specific foods. Often, it may be safest to omit all foods with egg ingredients from a student’s diet while at school.
However, the implications of this in other areas of dietetics are huge—some clients and patients who are listed as having egg allergies may be able to have a more liberalized diet than previously thought. When it came to my niece, her parents received general advice from her allergist but were unable to locate a nutrition professional to help them with further determining the safety of different foods (and, of course, I was no help). They only know what’s safe for her because she has eaten it before without a reaction—but every new egg-containing food is a risk they’re taking on alone.
While an oral food challenge always should be done in a clinical setting in the presence of a medical doctor and with access to epinephrine, the role of dietitians in this process is crucial. Helping patients to better define the parameters around their egg allergy can allow them an improved quality of life and help them develop a more positive relationship with food and their food allergy.
Food allergy research is constantly evolving, and it’s important for nutrition professionals to stay informed and be part of the process. Whether helping to introduce baked eggs or baked milk, or managing a different food allergy, the advice of dietitians is paramount to ensuring recommendations are followed safely but without unnecessary restrictions.
— Kim Crudele, RDN, is a New Jersey–based dietitian specializing in school nutrition and nutrition communications. She’s the owner of Well Balanced RD, where she does school and corporate wellness consulting. Kim is also a freelance writer concentrating on food, nutrition, health, and agriculture. She’s an avid gardener with dreams of starting her own CSA, a distance runner, and a dog lover. She’s currently pursuing her Master of Arts in communications at Northern Arizona University.